Provider Demographics
NPI:1649860354
Name:THE CHATTANOOGA SPINE AND WELLNESS INSTITUTE, INC
Entity type:Organization
Organization Name:THE CHATTANOOGA SPINE AND WELLNESS INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:SHEFFIELD
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-296-2604
Mailing Address - Street 1:1745 PHOENIX BLVD STE 335
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5569
Mailing Address - Country:US
Mailing Address - Phone:423-296-2604
Mailing Address - Fax:
Practice Address - Street 1:1745 PHOENIX BLVD STE 335
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5569
Practice Address - Country:US
Practice Address - Phone:423-296-2604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHATTANOOGA SPINE AND WELLNESS INSTITUTE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3957OtherMEDICARE PTAN